Risk factors of incisional hernia at the umbilical specimen extraction site in patients with laparoscopic colorectal cancer surgery

Abstract

Incisional hernia (IH) is a frequent complication following laparoscopic colorectal surgery. The present study investigated the risk factors for IH after laparoscopic surgery for colorectal cancer. Methods: A retrospective study was conducted on 202 patients who underwent laparoscopic surgery for colorectal cancer. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with IH. Results: The overall incidence of IH was 25.7% (52 of 202). The univariate analysis showed that female sex (P = 0.004), a high body mass index (P < 0.001), non-current smoking habit (P = 0.043), low level of hemoglobin (P = 0.035), high subcutaneous fat area (P < 0.001), high visceral fat area (P = 0.006), low skeletal muscle area (P = 0.001), long distance between the inner edges of the rectus abdominis muscle (P = 0.001), long protrusion of the peritoneum at the umbilical site (P < 0.001), and lymph node metastasis (P = 0.007) were significantly more frequent in the group with IH than in the group without it. The multivariate logistic regression analysis revealed an older age (10-year increments: odds ratio [OR], 1.576; 95% confidence interval [CI], 1.027-2.419; P = 0.037), lymph node metastasis (OR, 2.384; 95% CI, 1.132-5.018; P = 0.022) and lengthy protrusion of the peritoneum at the umbilical site (10-mm increments: OR, 5.555; 95% CI, 3.058-10.091; P < 0.001) were independent risk factors for IH. Conclusion: Our findings suggest that older age, lymph node metastasis, and lengthy protrusion of the peritoneum at the umbilical site are risk factors for IH after laparoscopic surgery for colorectal cancer. An assessment using these factors before the operation and the implementation of countermeasures might help prevent IH.

Impact of non-muscle cutting periumbilical transverse incision on the risk of incisional hernia as compared to midline incision during laparoscopic colon cancer surgery: a study protocol for a multi-centre randomised controlled trial

“…The site for protective faecal diversion is usually outside the midline and can be used for specimen extraction to avoid two small incisions. Nonetheless, the midline incision is frequently used for rectal cancer surgery [20]. If this study proves the superiority of the nonmuscle-cutting periumbilical transverse incision, it can be used for rectal cancer surgery instead of the midline incision, preserving its benefits for patients with rectal cancer.…”

Impact of non-muscle cutting periumbilical transverse incision on the risk of incisional hernia as compared to midline incision during laparoscopic colon cancer surgery: A study protocol for a multi-centre randomised controlled trial

“…Nonetheless, the midline incision is frequently used for rectal cancer surgery. (20) If this study proves the superiority of the non-muscle cutting transverse incision, this technique can be used for rectal cancer surgery instead of midline incision, maintaining its bene ts in patients with rectal cancer.…”

The first case of robotic‐assisted transabdominal retrorectus repair for incisional hernia in Japan

“…Minimally invasive surgery is performed in a variety of areas. The incidence of incisional hernia is reported to be 0.2%–4.8% after RARP 4,10 and 0.9%–25.7% after laparoscopic colorectal surgery 2,3 . During the watchful waiting period for incisional hernias, 19%–33% of patients end up undergoing surgery, with an emergency operation rate of 4%–7.7% 11,12 .…”

“…An incisional hernia is one of the complications after abdominal surgery, with a reported incidence of 11%–20% 1 . Although minimally invasive surgery is widely used in various surgical areas, incisional hernia remains a frequent complication, ranging from 0.9% to 25.7% 2–4 . Laparoscopic incisional hernia repair with intraperitoneal onlay mesh (IPOM) is widely performed because of the simplicity of its technique and a low postoperative surgical site infection rate.…”

“…1 Although minimally invasive surgery is widely used in various surgical areas, incisional hernia remains a frequent complication, ranging from 0.9% to 25.7%. [2][3][4] Laparoscopic incisional hernia repair with intraperitoneal onlay mesh (IPOM) is widely performed because of the simplicity of its technique and a low postoperative surgical site infection rate. However, laparoscopic IPOM can come with non-negligible mesh-related complications such as mesh bulge, seroma, hematoma, chronic pain, intestinal fistula, mesh infection, and adhesive bowel obstruction.…”